Survey: Social Interaction and Technology Use Questionnaire

Please Read: Welcome to the Shyness Institute’s study on perceptions of technology and social interaction . To help us with our research, we would like you to answer some questions about how (and how much) you use technology and how you perceive social situations. All information collected will be held in strictest confidence. While this information may be published, numbers instead of names will be used on the questionnaires so that your anonymity is assured. This questionnaire will take about 15 minutes to complete. Thank you for your time and participation. Please do not this submit this questionnaire more than once.

Consent

I, , hereby consent to participate in the project described above. I have read and understand this statement.

Date:

Age:

Background Information

Name:

Birth Date:

Sex:

Are you in school? Yes No
If so, are you in grades 1 through 12? Yes No

What grade are you in?

If you are in college, what year?

If in graduate school, what year?

Have you completed a master degree? Yes No

Completed Ph.D.? Yes No

Working? Yes No
If so, are you working full time? Yes No

Working in a technical field? Yes No

Questions

Listed below are some activities that people do, both alone and with others. For each item, select the category that shows how often you engage in this activity.

What is the TOTAL number of hours a week that you spend on a computer?

0

Less than 1

1-3

4-6

7-10

11-15

16-20

20+

Of these hours, how many are used for academic activities?

0

Less than 1

1-3

4-6

7-10

11-15

16-20

20+

How many are used for other activities?

0

Less than 1

1-3

4-6

7-10

11-15

16-20

20+

What is your most common activity when using a computer? (check ONLY ONE)

games
surfing the internet
research for school
researching things unrelated to school

word processing
research for work
email

Do you use the internet more or less than your friends?
more less same as

How many hours a week do you spend doing the following activities:

Surfing the web

0

Less than 1

1-3

4-6

7-10

11-15

16-20

20+

Playing computer games

0

Less than 1

1-3

4-6

7-10

11-15

16-20

20+

Using email

0

Less than 1

1-3

4-6

7-10

11-15

16-20

20+

Participating in chat rooms

0

Less than 1

1-3

4-6

7-10

11-15

16-20

20+

Visiting sexual sites

0

Less than 1

1-3

4-6

7-10

11-15

16-20

20+

How many hours a week do you spend talking on the telephone?

0

Less than 1

1-3

4-6

7-10

11-15

16-20

20+

How many hours a week do you spend watching television?

0

Less than 1

1-3

4-6

7-10

11-15

16-20

20+

How many hours a week do you spend watching television with friends?

0

Less than 1

1-3

4-6

7-10

11-15

16-20

20+

How many hours a week do you spend socializing with friends?

0

Less than 1

1-3

4-6

7-10

11-15

16-20

20+

How many hours a week do you spend dating?

0

Less than 1

1-3

4-6

7-10

11-15

16-20

20+

How many hours a week do you spend with a significant other?

0

Less than 1

1-3

4-6

7-10

11-15

16-20

20+

How much time do you spend participating in extracurricular activities
(i.e., sports, clubs, student government, volunteer activities, etc.)?

0

Less than 1

1-3

4-6

7-10

11-15

16-20

20+

How much time do you spend volunteering in community activities?

0

Less than 1

1-3

4-6

7-10

11-15

16-20

20+

How much time do you spend interacting with your parents?

0

Less than 1

1-3

4-6

7-10

11-15

16-20

20+

How much time do you spend interacting with your brothers or sisters?

0

Less than 1

1-3

4-6

7-10

11-15

16-20

20+

How many times a week do you watch television while eating a meal?

0

Less than 1

1-3

4-6

7-10

11-15

16-20

20+

Where is the computer in your house (i.e. what room)?

Do you have one in your bedroom? Yes No

How many emails do you receive a day at work, on the average?

0

Less than 1

1-3

4-6

7-10

11-15

16-20

20+

How many emails that you receive at work are personal, on the average?

0

Less than 1

1-3

4-6

7-10

11-15

16-20

20+

How many emails do you receive a day at home, on the average?

0

Less than 1

1-3

4-6

7-10

11-15

16-20

20+

How many times a day do you check your email at work?

0

Less than 1

1-3

4-6

7-10

11-15

16-20

20+

How many times a day do you check your email at home?

0

Less than 1

1-3

4-6

7-10

11-15

16-20

20+

How many times a week do you check your email?

0

Less than 1

1-3

4-6

7-10

11-15

16-20

20+

When you use a computer, how much of the time do you work on projects with other people?

0

Less than 1

1-3

4-6

7-10

11-15

16-20

20+

If you are at home, do parents limit the time you spend using computers? Yes No

Are there consequences if you break the limits? Yes No

Do your parents use technology as a reward? Yes No

Do your parents use technology as a punishment? Yes No

Where do you have access to a computer? (check all that apply).

At school
At home
At work

Other
Do not have access

(Rank the following four questions in this order: 1 = most, to 4 = least)

If you need to talk to someone about something personal, do you prefer to 1st most likely thing to do (please only choose one):
email them write a letter telephone them speak to them in person

2nd most likely thing to do (please only choose one):
email them write a letter telephone them speak to them in person

3rd most likely thing to do (please only choose one):
email them write a letter telephone them speak to them in person

4th most likely thing to do (please only choose one):
email them write a letter telephone them speak to them in person

If you have a fight with a friend, what do you prefer to do most?
email them write a letter telephone them speak to them

If something important comes up in a relationship, what are you most likely to do?
email them write a letter telephone them speak to them in person

In general, would you rather talk to someone via email or on the telephone?
email them telephone them

Would you describe yourself as _____ introverted?

0

1

2

3

4

not at all

very much

Would you describe yourself as _____ extraverted?

0

1

2

3

4

not at all

very much

How outgoing are you?

0

1

2

3

4

not at all

very much

How shy are you?

0

1

2

3

4

not at all

very much

How lonely are you?

0

1

2

3

4

not at all

very much

What sports do you play (please list, in no particular order)?

Sport #1
Sport #2
Sport #3
Sport #4
Sport #5

Sport #6
Sport #7
Sport #8
Sport #9
Sport #10

How many hours a week do you spend engaging in athletic activities?

Less than 1

1-3

4-6

7-10

11-19

20 or more

Of what group in school do you consider yourself a member?

jocks

popular

nerds

other (describe)

alternative

With what group at work do you consider yourself a member?

jocks

popular

nerds

other (describe)

alternative

With what groups do you get along the best?

Get along with best (please choose only one):

jocks

nerds

alternative

popular

other (describe)

Get along with 2nd best (please choose only one):

jocks

nerds

alternative

popular

other (describe)

Get along with 3rd best (please choose only one):

jocks

nerds

alternative

popular

other (describe)

Get along with 4th best (please choose only one):

jocks

nerds

alternative

popular

other (describe)

If in school, what is your grade point average?

How many close friends do you have?
Of these, how many are male? female?

Do you tend to focus your attention and thoughts more to (Choose one)
the future
the present
the past?

Imagine a situation in which you meet someone you would like to know better, someone who might possibly become a friend. However, for some reason, the conversation is not coming out as you would like it to.

Do you (check all that apply; for each, choose how much):

a. blame yourself? How much?

0

1

2

3

4

not at all

very much

b. blame the other person? How much?

0

1

2

3

4

not at all

very much

c. assume that this kind of thing just happens sometimes, no one is to blame?

0

1

2

3

4

not at all

very much

d. decide you’ll approach this person at the next opportunity and try again?

0

1

2

3

4

not at all

very much

Are you generally happy?

0

1

2

3

4

not at all

very much

Do you sometimes become angry over unimportant things?

0

1

2

3

4

not at all

very much

Do your moods change frequently?

0

1

2

3

4

not at all

very much

Are you sad often?

0

1

2

3

4

not at all

very much

Are you satisfied with your friendships?

0

1

2

3

4

not at all

very much

Are you satisfied with your primary relationship?

0

1

2

3

4

not at all

very much

Are you satisfied with your family life?

0

1

2

3

4

not at all

very much

Are you satisfied with relationships formed on the internet?

0

1

2

3

4

not at all

very much

Do you consider yourself a good communicator?

0

1

2

3

4

not at all

very much

Do others tell you that you are a good communicator?

0

1

2

3

4

not at all

very much

Do other people give you positive feedback?

0

1

2

3

4

not at all

very much

Do other people give you negative feedback?

0

1

2

3

4

not at all

very much

Do you feel supported by your family?

0

1

2

3

4

not at all

very much

Do you feel supported by your school?

0

1

2

3

4

not at all

very much

Do you feel supported at work?

0

1

2

3

4

not at all

very much

Do you feel supported by your community?

0

1

2

3

4

not at all

very much

Do you have a good social support system?

0

1

2

3

4

not at all

very much

I understand that no identifying information is included in this data.
In submitting this data, I give permission for its unlimited use in research.